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Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-Sectional Survey Study

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Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-Sectional Survey Study JOURNAL OF MEDICAL INTERNET RESEARCH Bowman et al Original Paper Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-sectional Survey Study Leigh Bowman1, PhD; Kin On Kwok2,3,4, PhD; Rozlyn Redd5, PhD; Yuanyuan Yi2, MPH; Helen Ward1,5, PhD; Wan In Wei2, MPhil; Christina Atchison5, PhD; Samuel Yeung-Shan Wong2, MD 1MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College, London, United Kingdom 2JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong 3Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong 4Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong 5Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom Corresponding Author: Kin On Kwok, PhD JC School of Public Health and Primary Care The Chinese University of Hong Kong Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital Shatin, New Territories Hong Kong Hong Kong Phone: 852 22528405 Email: [email protected] Abstract Background: Given the public health responses to previous respiratory disease pandemics, and in the absence of treatments and vaccines, the mitigation of the COVID-19 pandemic relies on population engagement in nonpharmaceutical interventions. This engagement is largely driven by risk perception, anxiety levels, and knowledge, as well as by historical exposure to disease outbreaks, government responses, and cultural factors. Objective: The aim of this study is to compare psychobehavioral responses in Hong Kong and the United Kingdom during the early phase of the COVID-19 pandemic. Methods: Comparable cross-sectional surveys were administered to adults in Hong Kong and the United Kingdom during the early phase of the epidemic in each setting. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level, and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between the explanatory variables and the adoption of social distancing measures. Results: Data from 3431 complete responses (Hong Kong, 1663; United Kingdom, 1768) were analyzed. Perceived severity of symptoms differed by setting, with weighted percentages of 96.8% for Hong Kong (1621/1663) and 19.9% for the United Kingdom (366/1768). A large proportion of respondents were abnormally or borderline anxious (Hong Kong: 1077/1603, 60.0%; United Kingdom: 812/1768, 46.5%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (Hong Kong: 94.0%-98.5%; United Kingdom: 69.2%-93.5%; all percentages weighted), with Hong Kong identifying additional routes. Hong Kong reported high levels of adoption of various social distancing measures (Hong Kong: 32.6%-93.7%; United Kingdom: 17.6%-59.0%) and mask-wearing (Hong Kong: 98.8% (1647/1663); United Kingdom: 3.1% (53/1768)). The impact of perceived severity of symptoms and perceived ease of transmission of COVID-19 on the adoption of social distancing measures varied by setting. In Hong Kong, these factors had no impact, whereas in the United Kingdom, those who perceived their symptom severity as ªhighº were more likely to adopt social distancing (adjusted odds ratios [aORs] 1.58-3.01), and those who perceived transmission as ªeasyº were prone to adopt both general social distancing (aOR 2.00, 95% CI 1.57-2.55) and contact avoidance (aOR 1.80, 95% CI 1.41-2.30). The impact of anxiety on adopting social distancing did not vary by setting. https://www.jmir.org/2021/3/e23231 J Med Internet Res 2021 | vol. 23 | iss. 3 | e23231 | p. 1 (page number not for citation purposes) XSL·FO RenderX JOURNAL OF MEDICAL INTERNET RESEARCH Bowman et al Conclusions: Our results suggest that health officials should ascertain baseline levels of risk perception and knowledge in populations, as well as prior sensitization to infectious disease outbreaks, during the development of mitigation strategies. Risk should be communicated through suitable media channelsÐand trust should be maintainedÐwhile early intervention remains the cornerstone of effective outbreak response. (J Med Internet Res 2021;23(3):e23231) doi: 10.2196/23231 KEYWORDS COVID-19; novel coronavirus; pandemic; behavioural response; risk perceptions; anxiety; comparative; Hong Kong; United Kingdom To elucidate these relationships, a more thorough comparative Introduction analysis is required. However, studies in different countries In December 2019, a novel coronavirus, SARS-CoV-2, emerged often use different metrics to measure the same behavior, which in Wuhan, Hubei Province, China, and spread rapidly can lead to difficulty when interpreting the significance of worldwide, forming the second pandemic of the 21st century heterogeneous contexts. [1]. The progression of the disease has varied by region. As of In this study, we examined and compared public perception and August 2, 2020, there have been at least 17 million cases of adoption of preventive behaviors in response to the early phase COVID-19 and over 670,000 deaths globally [2]. of the COVID-19 pandemic in two different settings: Hong Prior to the availability of effective treatments and vaccines, Kong and the United Kingdom. We further investigated the strategies to mitigate the impact of the pandemic have been factors associated with greater adoption of different types of primarily nonpharmaceutical [3], mainly focusing on public social distancing measures. Our results have immediate health promotion of using simple but effective preventive implications on how health officials plan and communicate measures [4,5]. Many important control strategies currently strategies to mitigate the ongoing COVID-19 pandemic to promoted by governments require public participation, either communities. through direct adoption of preventative behaviors, such as handwashing or wearing face masks, or through compliance Methods with social distancing policies, such as recommendations to avoid public transport and mass gatherings. Study Design and Recruitment In Hong Kong and the United Kingdom, cross-sectional surveys Previous studies of the severe acute respiratory syndrome and were conducted during the early phase of the COVID-19 influenza pandemics showed that governments should account pandemic, when limited government-level interventions were for risk perception and anxiety when promoting preventative in place [5,18]. The survey period in Hong Kong was from measures. There is evidence that higher perceived risk of January 24 to February 13, 2020, and that in the United infection is associated with increased adoption of precautionary Kingdom was from March 17 to 18, 2020. In Hong Kong, the measures [6,7], while increased anxiety has also been shown to first laboratory-confirmed case of COVID-19 was reported on increase the likelihood that people will engage in protective January 23, 2020, and the number of cases rose to 53 by behaviors [8]. Moreover, longitudinal data suggest that these February 13, 2020 [19]; meanwhile, in the United Kingdom, perceptions, behaviors and anxieties change with context and the first two laboratory-confirmed cases were reported on over time as uncertainty about disease severity decreases and January 31, 2020, and the number of cases rose to 2626 by knowledge of transmission increases [9]. March 18, 2020 [20]. During the current COVID-19 pandemic, researchers have In Hong Kong, all 452 district councilors were invited to examined public risk perceptions and knowledge in various distribute an open web-based survey by sharing a survey link countries, including Finland [10], Israel [11], Italy [12], Nigeria and promotion messages on their webpages, social media [13], the United States [14,15], South Korea [16] and Vietnam platforms, or any channels which they usually used to convey [17]. However, only a few studies have identified the factors information to their targeted residents. Individuals aged ≥18 associated with greater adoption of preventative measures or years who understood Chinese and lived in Hong Kong were how these associations vary by context. In Hong Kong, both eligible to participate [5]. Respondents were compensated with greater understanding of COVID-19 and increased anxiety were HK $10 (US $1.29) in the form of a cash coupon. In the United associated with greater adoption of social distancing behaviors Kingdom, the web-based survey was not open (users were [5], whereas in the United Kingdom, there was a significant required to log in) and was administered by YouGov, a market socioeconomic gradient in the ability to adopt and comply with research company, to members of its panel of ≥800,000 social distancing measures, specifically the ability to work from individuals (aged ≥18 years) as part of their omnibus survey home and the ability to self-isolate [18]. [21]. Our UK sample was obtained through a nonprobabilistic This initial evidence that there is variation across context in active sampling method, and emails were sent to randomly affective responses, risk perceptions, and the impact of selected individuals with particular characteristics to match the sociodemographic factors on the
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